Provider Demographics
NPI:1972722890
Name:GAGE, DENISE A (MA, CCC, LSLS, CERT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:GAGE
Suffix:
Gender:F
Credentials:MA, CCC, LSLS, CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 W ARKANSAS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5826
Mailing Address - Country:US
Mailing Address - Phone:817-460-0378
Mailing Address - Fax:817-469-1195
Practice Address - Street 1:3111 W ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5826
Practice Address - Country:US
Practice Address - Phone:817-460-0378
Practice Address - Fax:817-469-1195
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004384601Medicaid
TX1104839786OtherSPEECH ENTERPRISES, INC. NPI
TX01040089OtherAMERIGROUP